Method and Apparatus for Coupling Soft Tissue to Bone

ABSTRACT

A method and apparatus for coupling a soft tissue implant into a locking cavity formed within a bone is disclosed. A bone engaging fastener is coupled to bone. A second fastener is coupled to a suture construction. The second fastener is coupled to the first fastener. Soft tissue is coupled to the suture construction.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.12/196,405 filed on Aug. 22, 2008, which is a continuation-in-partapplication of: (a.) U.S. patent application Ser. No. 11/541,506 filedon Sep. 29, 2006, now U.S. Pat. No. 7,601,165 issued on Oct. 13, 2009;(b.) U.S. patent application Ser. No. 12/014,399 filed on Jan. 15, 2008,now U.S. Pat. No. 7,909,851 issued on Mar. 22, 2011; (c.) U.S. patentapplication Ser. No. 12/014,340 filed on Jan. 15, 2008, now U.S. Pat.No. 7,905,904 issued on Mar. 15, 2011; (d.) U.S. patent application Ser.No. 11/935,681 filed on Nov. 6, 2007, now U.S. Pat. No. 7,905,903 issuedon Mar. 15, 2011; (e.) U.S. patent application Ser. No. 11/869,440 filedon Oct. 9, 2007, now U.S. Pat. No. 7,857,830 issued on Dec. 28, 2010;(f.) U.S. patent application Ser. No. 11/784,821 filed on Apr. 10, 2007;(g.) U.S. patent application Ser. No. 11/347,661 filed on Feb. 3, 2006,now U.S. Pat. No. 7,749,250 issued on Jul. 6, 2010; and (h.) U.S. patentapplication Ser. No. 11/347,662 filed on Feb. 3, 2006, now abandoned.The disclosures of the above applications are incorporated herein byreference.

FIELD

The present disclosure relates to method of coupling soft tissue to boneand, more particularly, to a method and apparatus using a plurality offasteners and suture cinch loop construction to couple soft tissue to abone.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

It is commonplace in arthroscopic procedures to employ sutures andanchors to secure soft tissues to bone. Despite their widespread use,several improvements in the use of sutures and suture anchors may bemade. For example, the procedure of tying knots may be very timeconsuming, thereby increasing the cost of the procedure and limiting thecapacity of the surgeon. Furthermore, the strength of the repair may belimited by the strength of the knot. This latter drawback may be ofparticular significance if the knot is tied improperly as the strengthof the knot in such situations may be significantly lower than thetensile strength of the suture material.

To improve on these uses, sutures having a single preformed loop havebeen provided. FIG. 1 represents a prior art suture construction. Asshown, one end of the suture is passed through a passage defined in thesuture itself. The application of tension to the ends of the suturepulls a portion of the suture through the passage, causing a loop formedin the suture to close. Relaxation of the system, however may allow aportion of the suture to translate back through the passage, thusrelieving the desired tension.

It is an object of the present teachings to provide an alternativedevice for anchoring sutures to bone and soft tissue. The device, whichis relatively simple in design and structure, is highly effective forits intended purpose.

SUMMARY

To overcome the aforementioned deficiencies, a method for configuring abraided tubular suture and a suture configuration are disclosed. Themethod includes passing a first end of the suture through a firstaperture into a passage defined by the suture and out a second aperturedefined by the suture so as to place the first end outside of thepassage. A second end of the suture is passed through the secondaperture into the passage and out the first aperture so as to place thesecond end outside of the passage.

A method of surgically implanting a suture construction in a bone isdisclosed. A suture construction is formed by passing the suture througha bore defined by a locking member. A first end of the suture is passedthrough a first aperture within the suture into a passage defined by thesuture and out a second aperture defined by the suture so as to placethe first end outside of the passage and define a first loop. A secondend of the suture is then passed through the second aperture into thepassage and out the first aperture so as to place the second end outsideof the passage, and define a second loop. A fastener is coupled to bone.Soft tissue is then passed through the first and second loops. Thelocking member is coupled to the fastener. Tension is applied onto thefirst and second ends to constrict the first and second loops about thesoft tissue.

In another embodiment, a method of surgically implanting a suture isdisclosed. The suture is passed through a bore defined by a firstfastener. A suture construction is formed by passing the suture througha bore defined by a locking member. A first end of the suture is passedthrough a first aperture within the suture into a passage defined by thesuture and out a second aperture defined by the suture so as to placethe first end outside of the passage and define a first loop. A secondend of the suture is then passed through the second aperture into thepassage and out the first aperture so as to place the second end outsideof the passage, and define a second loop. A second fastener is coupledbetween the first and second loops. After the fastener is coupled to thepatient, tension is applied onto the first and second ends to constrictat least one of the first and second loops about the soft tissue.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present disclosure in any way.

FIG. 1 represents a prior art suture configuration;

FIGS. 2A and 2B represent suture constructions according to theteachings;

FIG. 3 represents the formation of the suture configuration shown inFIG. 4A;

FIGS. 4A and 4B represent alternate suture configurations;

FIGS. 5-7 represent further alternate suture configurations;

FIG. 8 represents the suture construction according to FIG. 5 coupled toa bone engaging fastener;

FIGS. 9-11B represent the coupling of the suture construction accordingto FIG. 5 to a bone screw;

FIGS. 12A-12E represent the coupling of a soft tissue to an ACLreplacement in a femoral/tibial reconstruction;

FIGS. 13A-13D represent a close-up view of the suture shown in FIGS.1-11C;

FIGS. 14A and 14B represent side and top views of a suture constructionused to couple soft tissue to bone;

FIGS. 15A-15D represent an alternate method of coupling soft tissue tobone;

FIGS. 16A-16D represent yet another method for coupling soft tissue tobone;

FIG. 17 is an alternate method of coupling soft tissue to bone;

FIGS. 18A-18B represent an alternate mechanism for coupling soft tissueto bone; and

FIGS. 19A-19C represent another method of coupling soft tissue to bone.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features.

FIG. 2A represents a suture construction 20 according to the presentteachings. Shown is a suture 22 having a first end 24 and a second end26. The suture 22 is formed of a braided body 28 that defines alongitudinally formed hollow passage 30 therein. First and secondapertures 32 and 34 are defined in the braided body 28 at first andsecond locations of the longitudinally formed passage 30.

Briefly referring to FIG. 3, a first end 24 of the suture 22 is passedthrough the first aperture 32 and through longitudinal passage 30 formedby a passage portion and out the second aperture 34. The second end 26is passed through the second aperture 34, through the passage 30 and outthe first aperture 32. This forms two structures or loops 46 and 46′.Structures defined herein can be loops, knots or tangles, each havingunique properties. As seen in FIG. 2B, the relationship of the first andsecond apertures 32 and 34 with respect to the first and second ends 24and 26 can be modified so as to allow a bow-tie suture construction 36.As described below, the longitudinal and parallel placement of first andsecond suture portions 38 and 40 of the suture 22 within thelongitudinal passage 30 resists the reverse relative movement of thefirst and second portions 38 and 40 of the suture once it is tightened.

The first and second apertures are formed during the braiding process asloose portions between pairs of fibers defining the suture. As furtherdescribed below, the first and second ends 24 and 26 can be passedthrough the longitudinal passage 30 multiple times. It is envisionedthat either a single or multiple apertures can be formed at the ends ofthe longitudinally formed passage.

As best seen in FIGS. 4A and 4B, a portion of the braided body 28 of thesuture defining the longitudinal passage 30 can be braided so as to havea diameter larger than the diameter of the first and second ends 24 and26. Additionally shown are first through fourth apertures 32, 34, 42,and 44. These apertures can be formed in the braiding process or can beformed during the construction process. In this regard, the apertures32, 34, 42, and 44 are defined between adjacent fibers in the braidedbody 28. As shown in FIG. 4B, and described below, it is envisioned thesutures can be passed through other biomedically compatible structures.

FIGS. 5-7 represent alternate constructions wherein a plurality of loops46 a-d are formed by passing the first and second ends 24 and 26 throughthe longitudinal passage 30 multiple times. The first and second ends 24and 26 can be passed through multiple or single apertures defined at theends of the longitudinal passage 30. The tensioning of the ends 24 and26 cause relative translation of the sides of the suture with respect toeach other.

Upon applying tension to the first and second ends 24 and 26 of thesuture 22, the size of the loops 46 a-d is reduced to a desired size orload. At this point, additional tension causes the body of the suturedefining the longitudinal passage 30 to constrict about the parallelportions of the suture within the longitudinal passage 30. Thisconstriction reduces the diameter of the longitudinal passage 30, thusforming a mechanical interface between the exterior surfaces of thefirst and second parallel portions as well as the interior surface ofthe longitudinal passage 30.

As seen in FIGS. 8-11B, the suture construction can be coupled tovarious biocompatible hardware. In this regard, the suture construction20 can be coupled to an aperture 52 of the bone engaging fastener 54.Additionally, it is envisioned that soft tissue or bone engaging members56 can be fastened to one or two loops 46. After fixing the boneengaging fastener 54, the members 56 can be used to repair, forinstance, a meniscal tear. The first and second ends 24, 26 are thenpulled, setting the tension on the loops 46, thus pulling the meniscusinto place. Additionally, upon application of tension, the longitudinalpassage 30 is constricted, thus preventing the relaxation of the tensioncaused by relative movement of the first and second parallel portions38, 40, within the longitudinal passage 30.

As seen in FIGS. 9-11B, the loops 46 can be used to fasten the sutureconstruction 20 to multiple types of prosthetic devices. As describedfurther below, the suture 22 can further be used to repair and couplesoft tissues in an anatomically desired position. Further, retraction ofthe first and second ends allows a physician to adjust the tension onthe loops between the prosthetic devices.

FIG. 11B represents the coupling of the suture construction according toFIG. 2B with a bone fastening member. Coupled to a pair of loops 46 and46′ are tissue fastening members 56. The application of tension toeither the first or second end 24 or 26 will tighten the loops 46 or 46′separately.

FIGS. 12A-12E represent potential uses of the suture constructions 20 inFIGS. 2A-7 in an ACL repair. As can be seen in FIG. 12A, thelongitudinal passage portion 30 of suture construction 20 can be firstcoupled to a fixation member 60. The member 60 can have a first profilewhich allows insertion of the member 60 through the tunnel and a secondprofile which allows engagement with a positive locking surface uponrotation. The longitudinal passage portion 30 of the suture construction20, member 60, loops 46 and ends 24, 26 can then be passed through afemoral and tibial tunnel 62. The fixation member 60 is positioned orcoupled to the femur. At this point, a natural or artificial ACL 64 canbe passed through a loop or loops 46 formed in the suture construction20. Tensioning of the first and second ends 24 and 26 applies tension tothe loops 46, thus pulling the ACL 64 into the tunnel. In this regard,the first and second ends are pulled through the femoral and tibialtunnel, thus constricting the loops 46 about the ACL 64 (see FIG. 12B).

As shown, the suture construction 20 allows for the application of forcealong an axis 61 defining the femoral tunnel. Specifically, theorientation of the suture construction 20 and, more specifically, theorientation of the longitudinal passage portion 30, the loops 46, andends 24, 26 allow for tension to be applied to the construction 20without applying non-seating forces to the fixation member 60. As anexample, should the loops 24, 26 be positioned at the member 60,application of forces to the ends 24, 26 may reduce the seating forceapplied by the member 60 onto the bone.

As best seen in FIG. 12C, the body portion 28 and parallel portions 38,40 of the suture construction 20 remain disposed within to the fixationmember 60. Further tension of the first ends draws the ACL 64 up throughthe tibial component into the femoral component. In this way, sutureends can be used to apply appropriate tension onto the ACL 64 component.The ACL 64 would be fixed to the tibial component using a plug or screwas is known.

After feeding the ACL 64 through the loops 46, tensioning of the endsallows engagement of the ACL with bearing surfaces defined on the loops.The tensioning pulls the ACL 64 through a femoral and tibial tunnel. TheACL 64 could be further coupled to the femur using a transverse pin orplug. As shown in FIG. 12E, once the ACL is fastened to the tibia,further tensioning can be applied to the first and second ends 24, 26placing a desired predetermined load on the ACL. This tension can bemeasured using a force gauge. This load is maintained by the sutureconfiguration. It is equally envisioned that the fixation member 60 canbe placed on the tibial component 66 and the ACL pulled into the tunnelthrough the femur. Further, it is envisioned that bone cement orbiological materials may be inserted into the tunnel 62.

FIGS. 13A-13D represent a close-up of a portion of the suture 20. As canbe seen, the portion of the suture defining the longitudinal passage 30has a diameter d₁ which is larger than the diameter d₂ of the ends 24and 26. The first aperture 32 is formed between a pair of fiber members.As can be seen, the apertures 32, 34 can be formed between two adjacentfiber pairs 68, 70. Further, various shapes can be braided onto asurface of the longitudinal passage 30.

The sutures are typically braided of from 8 to 16 fibers. These fibersare made of nylon or other biocompatible material. It is envisioned thatthe suture 22 can be formed of multiple type of biocompatible fibershaving multiple coefficients of friction or size. Further, the braidingcan be accomplished so that different portions of the exterior surfaceof the suture can have different coefficients of friction or mechanicalproperties. The placement of a carrier fiber having a particular surfaceproperty can be modified along the length of the suture so as to placeit at varying locations within the braided constructions.

FIGS. 14A and 14B represent the coupling of soft tissue to a bone. Shownis a plurality of bone engaging fasteners 60 coupled to sutureconstructions 22 shown in FIG. 2A or FIG. 4. Each fastener 60 is coupledto a bone by being pressed into or threaded into an aperture formedwithin the bone. Adjoining fasteners are coupled together using loops 46from an adjacent suture construction 22.

The fasteners 60 define a locking feature 92 which is used to couple thefastener 60 to the bone. Disposed on a first end of the fastener 60 isan aperture 94 configured to hold the suture construction 22.Additionally, in the fastener 60 is a locking feature 100 configured toengage with one of the first or second loops 46 or 47 of an adjacentsuture construction 22. Returning briefly to FIG. 14A, a suture end 26and first loop 46 can be passed around or through an aperture 84 in softtissue.

The first loop 46 is then fed around or through a second aperture 84′formed in the soft tissue 80. After passing through the aperture 84′,the first loop 46 is coupled to the coupling feature 100 in an adjacentbone coupling fastener 60. At this point, the first and second ends 24,26 of the suture 22 are pulled tight, tightening the suture loop 46about the soft tissue 80. This pulls the soft tissue 80 against asurface of the bone. This can be used to couple soft tissue in ananatomy such in the repair of a rotator cuff.

It is envisioned that a plurality of fasteners 60 can have associatedsuture constructions 22 which can similarly be coupled to adjacentfasteners 60. Alternatively, the loops 46, 47 can looped around orpassed through the soft tissue 80 and then can be coupled to thecoupling feature 100 of its fastener 60.

FIGS. 15A-15D represent an alternate method of coupling soft tissue 80to a bone. As shown in FIG. 15A, a first bone coupling fastener 60 iscoupled to an aperture 63 formed in the bone. The bone coupling fastener60 defines a fastener accepting bore 96. The bore 96 may be a throughbore or may terminate within the fastener 96. The fastener acceptingbore 96 is configured to accept a suture bearing fastener 98. The firstloop 46 can be coupled to the second loop 47 to fix the soft tissue 80.

The suture bearing fastener 98 defines an aperture 104 configured toaccept the suture construction 22 according to any of the presentteachings. As described below, the fastener 98 can also have a concavesuture locking feature 100. Disposed at a proximal end 102 of thefastener 96 can be soft tissue piercing feature 105 which can be anacute angle. Additionally, the suture bearing fastener 98 can havelocking features to facilitate the coupling to the bore 96 of the bonecoupling fastener 60.

As seen in FIG. 15B, the suture construction of FIGS. 1-7 can be coupledto the suture bearing fastener 98 through the suture bearing aperture104 using a knot. After the suture bearing fastener 98 is pressedthrough or adjacent to the soft tissue 80, the suture construction 22can be looped over the soft tissue 80 and engaged with the concavelocking feature 100. The suture bearing fastener 98 can be pressed intothe fastener 60 to lock the suture 22 into place. Tension can then beapplied to the suture 22 construction to constrict the loop 46 or loops46 and 47 about the soft tissue 80.

As seen in FIGS. 15C and 15D, the soft tissue 80 can be threaded throughthe loops 46 and 47 prior to or after the coupling of the suture bearingfastener 98 to the bone engaging fastener 60. A guide wire 99 can becoupled to the bone through the fastener bore 96. The guide wire 99 isthen used to align the suture bearing fastener 98 through the softtissue 80 and into the bore 96 of fastener 60.

As shown in FIG. 16A-16C, one loop 46 of the suture construction 22 canhave a fastening element 112 coupled thereto. This fastener element 112can take the form of a hook having an aperture which accepts the suturefrom a loop 47. The loop 46 of the suture construction can be passedthrough the aperture 84 formed in the soft tissue 80.

FIG. 16D shows the fastener element 112 can be coupled to the first loop46. After the first and second loops 46 and 47 are coupled togetherabout the soft tissue 80, tension can be applied to the ends of theconstruction to pull the soft tissue to the bone.

As shown in FIG. 17, bone engaging fastener 60 can have a bore 96defined therein. The bore 96 can have a defined fastening loop 114 whichis used to couple a suture construction 22 to the fastener 60. In thisregard, it is envisioned the passage portion 30 of the sutureconstruction can be fixed within the fastening loop. One or both loops46 and 47 can then be passed though an aperture 84 defined in the softtissue 80. These loops of material can be hooked to a hook 116 definedwithin the bore 96. The application of tension to the ends pulls thesoft tissue to the bone without the use of knots or additionalfasteners.

FIGS. 18A and 18B represent an alternate method of coupling soft tissue80 to bone. Shown is a bone engaging fastener 60 defining an internalbore 96. The internal bore 96 defines a locking mechanism such a throughpin 120. Disposed about the locking mechanism is a suture construction22 having a single loop 46. Disposed on the loop 46 is a locking hook122.

As shown in FIG. 18B, the locking hook 122 can be used to couple thefastener 60 to a suture loop 124 passed through an aperture 84 formed insoft tissue 80. The application of tension to the ends 22 and 26 of thesuture construction 22 pulls the locking hook 122 and suture 124 intothe bore 96, thus locking the soft tissue 80 to the bone.

As seen in FIGS. 19A-19C, the fastener 60 can have a pair of sutureconstructions 22 and 22′. The first suture 22 can have a coupling member122, while the second suture 22′ can have a loop 46 threaded through thesoft tissue 80. After the loop 46 is threaded through or around the softtissue, the locking member 122 is coupled to the loop 46. Theapplication of tension to the ends 26 of the suture constructions 22 and22′ pull the locking member 122 into a bore 96 formed by the fastener60. This locks the loop 46 into position. Tension on the end 26 ofsuture 22 then pulls the soft tissue to the bone.

It should be noted that while the interior bore of the fasteners 60 isshown as being smooth, it is envisioned that the interior surface canhave features such as barbs or locking tabs to facilitate the couplingof the suture engaging fastener 98 with the bone engaging fastener 60.Additionally, the interior bores can define driving surfaces or featuressuch as a hex head.

The description of the invention is merely exemplary in nature and,thus, variations that do not depart from the gist of the invention areintended to be within the scope of the invention. For example, any ofthe above mentioned surgical procedures is applicable to repair of otherbody portions. For example, the procedures can be equally applied to therepair of wrists, elbows, ankles, and meniscal repair. The suture loopscan be passed through bores formed in soft or hard tissue. It is equallyenvisioned that the loops can be passed through or formed around anaperture or apertures formed in prosthetic devices, e.g. humeral,femoral or tibial stems. Such variations are not to be regarded as adeparture from the spirit and scope of the invention.

1. A method of coupling a soft tissue to a bone, comprising: determiningan area of the bone to couple a first anchor and a second anchor,wherein: (i) the first anchor includes a first bone engaging feature, afirst aperture, and a first suture member, the first suture memberincluding a braided body disposed in the first aperture and defining alongitudinally extending passage, and a first end extending from thebraided body and passing through the passage and the first aperture soas to place the first end outside of the passage, and define anadjustable first loop, and (ii) the second anchor includes a second boneengaging feature and a first coupling feature; forming a first hole inthe area; forming a second hole in the area adjacent to the first hole;positioning the first anchor in the first hole; positioning the secondanchor in the second hole; coupling the first loop to the soft tissue;and coupling the first loop to the first coupling feature.
 2. The methodaccording to claim 1, further comprising passing the first loop throughthe soft tissue.
 3. The method according to claim 2, further comprisingpassing the first loop through the soft tissue prior to coupling thefirst loop to the first coupling feature.
 4. The method according toclaim 3, further comprising: passing the first end through the firstloop; and passing the first end through the soft tissue.
 5. The methodaccording to claim 1, further comprising looping the first loop aroundthe soft tissue.
 6. The method according to claim 5, further comprisinglooping the first loop around the soft tissue prior to coupling thefirst loop to the first coupling feature.
 7. The method according toclaim 1, wherein the first coupling feature includes a hook configuredto receive the first loop, and wherein coupling the first loop to thefirst coupling feature includes coupling the first loop to the hook. 8.The method according to claim 1, further comprising adjusting a size ofthe first loop to compress the soft tissue against the bone by pullingon the first end of the first suture member.
 9. The method according toclaim 1 further comprising tensioning the first loop to compress thesoft tissue against the bone by pulling on the first end of the firstsuture member.
 10. The method according to claim 1, wherein the firstsuture member further includes a second end extending from the braidedbody and passing through the passage and the first aperture so as toplace the second end outside of the passage, and define an adjustablesecond loop, the method further comprising: passing the soft tissuethrough the second loop; and adjusting a size of the second loop tocompress the soft tissue against the bone by pulling on the second end.11. The method according to claim 1, wherein the first anchor furtherincludes a second coupling feature and a second end extending from thebraided body and passing through the passage and the first aperture soas to place the second end outside of the passage, and define aself-locking, adjustable second loop, the method further comprising:coupling the second loop to the soft tissue; and coupling the secondloop to one of the first coupling feature or the second couplingfeature.
 12. The method according to claim 1, wherein the first suturemember further includes a second end extending from the braided body andpassing through the passage and the first aperture so as to place thesecond end outside of the passage, and define an adjustable second loop,the method further comprising: coupling the second loop to a thirdanchor in the bone adjacent to the first anchor.
 13. A method ofcoupling a soft tissue to a bone, comprising: determining an area of thebone to couple a first anchor, a second anchor, and a third anchor,wherein: (i) the first anchor includes a first bone engaging feature anda first suture member coupled to the first anchor and forming anadjustable first loop, (ii) the second anchor includes a second boneengaging feature, a first coupling feature, and a second suture membercoupled to the second anchor and forming an adjustable second loop; and(iii) the third anchor includes a third bone engaging feature and asecond coupling feature; positioning the first anchor, the secondanchor, and the third anchor in the bone adjacent to each other in thearea; coupling the first loop to the soft tissue and to the firstcoupling feature of the second anchor; and coupling the second loop tothe soft tissue and to the second coupling feature of the third anchor.14. The method according to claim 13, further comprising passing thesecond loop through the first loop.
 15. The method according to claim13, further comprising passing at least one of the first loop or thesecond loop through the soft tissue.
 16. The method according to claim13, further comprising looping at least one of the first loop or thesecond loop around the soft tissue.
 17. The method according to claim13, further comprising: adjusting a first size of the first loop tocompress the soft tissue against the bone by pulling on a first end ofthe first suture member; and adjusting a second size of the second loopto compress the soft tissue against the bone by pulling on a second endof the second suture member.
 18. The method according to claim 13,further comprising passing the soft tissue through the first loop andthe second loop.
 19. The method according to claim 13, wherein: thefirst suture member includes: (i) a first aperture, (ii) a first braidedbody disposed in the first aperture and defining a longitudinallyextending first passage, and (iii) a first end extending from the firstbraided body and passing through the first passage and the firstaperture so as to place the first end outside of the first passage, anddefine the first loop; and the second suture member includes: (i) asecond aperture, (ii) a second braided body disposed in the secondaperture and defining a longitudinally extending second passage, and(iii) a second end extending from the second braided body and passingthrough the second passage and the second aperture so as to place thesecond end outside of the second passage, and define the second loop.20. A method of coupling a soft tissue to a bone, comprising:determining an area of the bone to couple a first anchor, a secondanchor, and a third anchor wherein: (i) the first anchor includes afirst bone engaging feature, a first aperture, and a first suturemember, the first suture member including a first braided body disposedin the first aperture and defining a longitudinally extending firstpassage, and a first end extending from the first braided body andpassing through the first passage and the first aperture so as to placethe first end outside of the first passage, and define a self-locking,adjustable first loop, (ii) the second anchor includes a second boneengaging feature, a second aperture, a first hook feature, and a secondsuture member, the second suture member including a second braided bodydisposed in the second aperture and defining a longitudinally extendingsecond passage, and a second end extending from the second braided bodyand passing through the second passage and the second aperture so as toplace a second end outside of the second passage, and define aself-locking, adjustable second loop, and (iii) the third anchorincludes a third bone engaging feature and a second hook feature;forming a first hole, a second hole, and a third hole adjacent to eachother in the area; positioning the first anchor, the second anchor, andthe third anchor in the first hole, the second hole, and the third hole,respectively; coupling the first loop and the second loop to the softtissue; coupling the first loop to the first hook feature; passing thesecond loop through the first loop; and coupling the second loop to thesecond hook feature.
 21. The method of claim 20, wherein the bone is ashoulder bone and the soft tissue is a rotator cuff, and whereincoupling the first loop and the second loop to the soft tissue includescoupling the first loop and the second loop to the rotator cuff.